04-5415 (RPL)I
BUILDING & SAFETY DEPARTMENT
C�.0,. Box 1504 (76.0) 777-7012
1 Of— i177,01)- 495 CALLE TAMPICO FAX (760) 777-7011
;g 1-1 LA QUINTA, CALIFORNIA 92253 INSPECTION REQUESTS (760) 777-7153
-
w BUILDING PERMIT
Qu►eaTA
Applcatlioumber . . .
. .. 04-00-005415 \ Date
7/12/04
1?rl rty Address . . ...
. . 51585 EL DORADO DR
APN:
772-250-996-173 -31349 -
Application description .
. . POOL - RESIDENTIAL
Property Zoning
LOW DENSITY -RESIDENTIAL
Application valuation
20000 _
Owner
Contractor
-- - - - - - - - - - - - - - - - - - - - ---
TOLL CA II
------------------ - - - ---
CALIFORNIA POOLS & SPAS
8901 E MOUNTAIN VW RD 200
:P.O. BOX 1280
SCOTTSDALE. AZ 85258
COACHELLA CA
92236
(760) 398-9222
WCC: STATE FUND
WC: 046.00061168
01/01/05
CSLB: 656128
10/31/04
CCC: C8-C27-C297C53
----------------------------=------------------------------------------------
Permit . ... . . . BLDG
POOL PERMIT
Additional desc
Permit Fee . . . . 207.00
Plan Check Fee
134.55
Issue Date
Valuation
19892
L
Qty Unit Charge Per
Extension
BASE FEE
45.00
18.00 9.0000 THOU
BLDG 2,001-25,000
162.00
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Permit MECH
POOL
Additional desc
Permit Fee . . . .
24.00 Plan Check Fee
6.00
Issue Date . .
Valuation . . . .
0
Qty Unit Charge Per
Extension
BASE FEE
15.00
1.00 9.0000 EA
MECH FURNACE <=100K
9..00
---------------------------------------
Permit . ... . . . ELEC
---------------------------------------
POOL PERMIT -RES
Additional desc
Permit Fee
45.00 Plan Check -Fee
11.25
Issue Date
Valuation
0
Qty Unit Charge Per
Extension
BASE FEE
15.00
1.00 30.0000 EA
ELEC PRIVATE SWIMMING POOL
30.00
P.O. Box 1504
78-495 CALLS TAMPICO
LA QUINTA, CALIFORNIA 92253
BUILDING & SAFETY DEPARTMENT
VOICE (760) 777-7012
FAX (760) 777-7011
INSPECTIONS (760) 777-7153
Application Number: Q q - .5Z/ 1 S Date:
Applicant:
Applicant's Mailing Address:
Architect or Engineer:
Architect or Engineer's Address:
Lic. No.:
BUILDING PERMIT DECLARATIONS
LICENSED CONTRACTOR'S DECLARATION
I hereby affirm under penalty of perjury that 1 am licensed under rovisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business and Professionals
,eode, and my Licenses is in II orc&and effect.
License Class
Date d Contractor
O NER-BUILDER DECLARATION
I hereby affirm under penalty of perjury that I am exempt from theContractors' State License Law for the following reason (Sec. 7031.5, Business and Professions Code: Any
city or county that requires a permit to construct, alter, improve, demolish, or repair any structure, prior to Its issuance, also requires the applicant for the permit to file a signed
statement that he or she is licensed pursuant to the provisions of the Contractors' State License Law (Chapter 9 (commencing with Section 7000) of Division 3 of the Business
and Professions Code) or that he or she is exempt therefrom and the basis for the alleged exemption. Any violation of Section 7031.5 by any applicant for a permit subjects
the applicant to a civil penalty of not more than five hundred dollars ($500).):
U I, as owner of the property, or my employees with wages as their sole compensation, will do the work, and the structure is not intended or offered for sale (Sec. 7044,
Business and Professions Code: The Contractors' State License Law does not apply to an owner of property who builds or improves thereon, and who does the work
himself or herself or through his or her own employees, provided that the improvements are not intended or offered for sale. If, however, the building or improvement is
sold within one year of completion, the owner -builder will have the burden of proving that he or she did not build or improve for the purpose of sale.).
U I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Sec. 7044, Business and Professions Code: The Contractors'
State License Law does not apply to an owner of property who builds or improves thereon, and who contracts for the projects with a centractor(s) licensed pursuant to
the Contractors' State License Law.).
U 1 am exempt under Sec. , BA P.C. for this reason
Date
WORKERS' COMPENSATION DECLARATION
I hereby affirm under penalty of perjury one of the following declarations:
I have and will maintain a certificate of consent to self -insure for workers' compensation, as provided for by Section 3700 of the Labor Code, for the performance
of the work for which this permit is issued.
—1 have and will manta' workers' compensation insurance, as required by Section 3700 of the Labor Code, for the performance of the work for which this permit is
is ued. work compensation insurance carver and o icy number re:
Cartier Policy Number i
I certify that, in the Oerformance of. the work for which s ermit is is ued, I shall not employ any person In any manner so as to become subject to the workers'
compensation.laws of Califomi and agree that, if h uld beco subject to the workers' compensation provisions of Section 3700 of the Labor Code, I shall
forthwith comply with those p v ions.
ate G
plicaniZ�
WARNING: FAILURE TO SECURE WORKERS' COMPEN . TI OVE GE IS UNLAWFUL, AND SHALL SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND
CIVIL FINES UP TO ONE HUNDRED THOUSAND DOLLARS ($1 0,000), I ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN
SECTION 3706 OF THE LABOR CODE, INTEREST, AND ATTOR EES.
CONSTRUCTION LENDING AGENCY
I hereby affirm under penalty of perjury that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.).
Lender's Name
Lender's Address f
APPLICANT ACKNOWLEDGEMENT
IMPORTANT Application is hereby made to the Director of Building and Safety for a permit subject to the conditions and restrictions set forth on this application.
1. Each person upon whose behalf this application is made, each person at whose request and for whose benefit work is performed under or pursuant to any permit
issued as a result of this application, the owner, and the applicant, each agrees to, and shall, defend, indemnify and hold harmless the City of La Quinta, its
officers, agents and employees for any act or omission related to the work beingormed under or following issuance of this permit.
2. Any pemvt issued as a result of this application becomes null and void if work is t coad within 180 days from date of issuance of such permit, or
cessation of work for 180 days will subject permit to cancellation.
I certify that 1 have read this application and state that the above information is correcL I a e to mply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives of this county t ler upon the above ntio a roperty for inspection purposes.
�B`a1a l� d Signature (Applicant or Agent):
0
Page
2
Application Number . . . . . 04-00005415 Date
7/12/04
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Permit . . . . . . PLUMBING
Additional desc
Permit Fee . . . . 33.00 Plan Check Fee
8.25
Issue Date . . . . Valuation . . . .
0
Qty Unit Charge Per
Extension
BASE FEE
15.00.
2.00 6.0000 EA PLB FIXTURE
12.00
1.00 3.0000 EA PLB WATER INST/ALT/REP
3.00
1.00 3.0000 EA PLB GAS PIPE 1-4 OUTLETS
'
3.00
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Permit . . . . . WALL/FENCE PERMIT
Additional desc
Permit Fee . . . . 15.00 Plan Check Fee
.00
Issue Date . . . . Valuation . . . .
108
Qty Unit Charge Per.
Extension
BASE FEE
15.00
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Special Notes and Comments
POOL/SPA, WATER FEATURE, BBQ(ANSI
Z21-58-1995),FIREPIT (496 AGAL) 5 L.F.
5' BLOCK WALL, CITY STANDARD.
ALARMS/BARRIERS SHALL BE IN PLACE AT
PRE -PLASTER INSPECTION.
Fee summary
-----------------
Permit Fee Total
Plan Check Total
Grand Total
Charged Paid
---------- ----------
324.' 00
---------
324..00 ..00
160.05 .00
484.05 .'00
Credited Due
---------- ----------
.00 324.00
.00 160.05
.00 484.05